final exam Flashcards

Question

key points 3

Answer 1

Maternal analgesia or anesthesia can affect neonatal neurobehavioral responses Epidural anesthesia and analgesia are the most effective avail. pharma pain relief methods for labor general anesthesia is rarely used for vaginal births but may be used for c-sec or whenever rapid anesthesia is needed in an emergency situation Opioid agonist analgesics in women with preexisting opioid dependence may cause symptoms of opioid withdrawal/abstience syndrome

Answer 2

couldnt find so no supp. notes

Answer 3

ASSESSMENT & DIAGNOSIS Prenatal data The nurse reviews the prenatal record to identify the woman’s individual needs and risks Latent phase (up to 3 cm of dilation) Active phase (4 - 7 cm of dilation) Transition phase (8 - 10 cm of dilation) Assessment and nursing diagnosis: -Determination of whether the woman is in true labor or false labor Contractions Cervix Fetus Obstetric triage -woman considered to be in true labor until a qualified provider determines she is not Admission to the labor unit includes prenatal data, the interview which includes spontaneous ROM, bloody or pink show, hx of sexual abuse, cultural factors Physical exam -general systems, VS, Leopold maneuvers (abd. palpitation), FHR and pattern -assess uterine contractions: frequency, duration, intensity, resting tone (mild/mod/strong) -vaginal exam cervical dilation, effacement, fetal descent -Lab and diagnostic tests urinalysis from urine specimen CBC, type and screen, HIV assessment of amniotic membrane and fluid all for signs of potential problems INTERVENTIONS & Plan of Care -general hygiene -nutrient and fluid intake (oral and IV) -Elimination void at least q2h catheter care bowel elimination, intervention -ambulation and positioning -supportive care during labor and birth (physical care and comfort measures, emotional support) -emergency interventions

Answer 4

-begins with full 10 cm dilation and complete effacement -pushing stage -infant is born 2 phases: latent: relatively calm with passive descent of infant through birth canal Active: pushing and urge to bear down. Ferguson reflex: urge to bear down CARE MANAGEMENT -preparation for birth position: supine, semi-recumbent, or lithotomy positions widely used in western society despite evidence that an upright position shortens labor -bearing down efforts "Valsalva maneuver" -FHR and pattern -use of fundal pressure contraindicated -immediate assessments and care of newborn

Answer 5

Perineal lacerations first degree: laceration extends thru skin and vaginal mucous membrane but not the underlying fascia and muscle Second degree: laceration extends thru the fascia and muscles of the perineal body, but not the anal sphincter Third degree: laceration involves the external anal sphincter Fourth degree: laceration extends completely thru the rectal mucosa and both external and internal anal sphincters -Cervical injuries -Episiotomy: an incision in the perineum used to enlarge the vaginal outlet. Lacks research to support its benefits

Answer 6

birth of baby -> expulsion of placenta -shortest stage of labor (about 10-15 min after birth) * may be problem if >30 min -sudden gush of dark blood -lengthening of umbilical cord -vaginal fullness -placental exam and disposal according to culture and hospital policy

Answer 7

CARE MANAGEMENT first 2 hours after birth -Assessment of maternal physical status -Signs of potential problems -excessive blood loss, unstable VS, LOC changes -adaptions to family

Answer 8

long, difficult, or abnormal labor -most common indication for a c-sec -5 P's affecting labor and birth (passengers, passageway, power, position, psychologic responses) Causes: 1. POWER: Abnormal uterine activity (alteration in Power) -Hypertonic uterine dysfunc.: def: frequent and painful contractions that are ineffective in causing cervical dilation or effacement. Force of contractions are in the midsection of the uterus rather than in the fundus, the uterus is unable to apply downward pressure to push the presenting part against the cervix. Woman are exhausted, and complain of loss of control. CARE: therapeutic rest, warm bath, shower, narcotic to ensure rest. -Hypotonic uterine dysfunc.: def: initially makes normal progress into the active phase of stage 1 labor but then the contractions become weak/inefficient/stop altogether CARE: ambulation, hydrotherapy, ROM, nipple stimulation, oxytocin 2. Secondary powers - problems bearing down dt large amount of analgesic 3. Abnormal labor patterns -patterns individual to each woman 4. Precipitous labor -labor that lasts less than 3 hours from the onset of contractions to the time of birth -potential complications for mom: uterine rupture, lacerations of birth canal, PPH -complications for fetus: shoulder dystocia, hypoxia, intracranial trauma PASSENGER: fetal causes of dystocia: -anomalies -cephalopelvic disproportion (CPD) aka fetopelvic disproportion (FPD) -malposition malpresentation (breech) -multifetal pregnancy PASSENGER: alterations in pelvic structure -pelvic dystocia: contractures of pelvic diameters that reduce capacity of bony pelvis, inlet, midpelvis, or outlet -soft-tissue dystocia: results from obstruction of the birth passage by an anatomic abnormality other than that of the bony pelvis POSITION: -maternal position affects uterine contractions, fetus, and pelvis PSYCHOLOGIC RESPONSES: -hormones and neurotransmitters released in response to stress can cause dystocia -sources of stress and anxiety vary

Answer 9

Induction of labor (IOL) -the chemical or mechanical initiation of uterine contractions before their spontaneous onset for the purpose of bringing about birth -labor may be induced either selectively or for indicated reasons Elective IOL: -no health indication -for mom/HCP's convenience -risks: risk of c-sec, risk of neonatal morbidity, increased costs *elective IOL should not be initiated until 39 wks gestation is completed Bishop's score for IOL: -rating system to evaluate inducibility or cervical ripeness Evaluates: dilation effacement station cervical consistency cervical position cervix station: Station is the measurement of the baby relative to the ischial spines. -5 to +5. 0 is at the ischial spines

Answer 10

A) Chemical agents -prostaglandins to ripen/soften and thin cervix -oxytocin- see below B) Physical/mechanical methods -Amniotomy "breaking the water" AROM -catheter insertion thru the intracervical canal and put pressure and stretch the lower uterine segment and cervix C) Alternative methods -sex, nipple stimulation, ambulation Oxytocin induction -is a hormone naturally produced by posterior pituitary gland -stimulates uterine contractions and milk let-down -synthetic oxytocin (Pitocin) may be used either to induce labor or augment labor that is progressing slowly because of inadequate uterine contractions

Answer 11

after labor has started spontaneously and progress is unsatisfactory stimulation of uterine contractions using oxytocin infusion and amniotomy ACTIVE MANAGEMENT: -FHR -inform mom of procedure -monitor contraction pattern -blood pressure, temp, respirations -intake/output -observe for nausea, vomiting, headache, hypotension

Answer 12

using either forceps or a vacuum extractor "forceps-assisted birth" "vacuum-assisted birth"

Answer 13

birth thru a transabdominal incision of the uterus VBAC: vag. birth after cesarean TOLAC: trial of labor after cesarean observing mom in labor for reasonable amount of time (4-6 hours) to assess the safety of vaginal birth complications and risks -obesity, age, PET, LGA, rural hospital anesthesia preparation preoperative care Pet is preeclampsia - high BP, proteinuria, kidney damage

Answer 14

C-sec or after regional anesthesia for vaginal birth needs special attention during recovery period Post-anesthesia recovery (PAR) unit

Answer 15

1. Meconium-stained amniotic fluid -indicates fetus passed stool prior to birth -dark green possible causes: -normal physiologic function of maturity (term or post-term) -breech presentation -hypoxia-induced peristalsis -umbilical cord compression 2. Shoulder dystocia -head is born but shoulder cannot pass under pubic arch -injuries related to asphyxia, brachial plexus damage, and fractures -mother's primary risk stems from excessive blood loss from uterine atony or rupture, lacerations, extension of episiotomy, or endometriosis 3. Prolapsed umbilical cord -cord lies below the presenting part of the fetus -contributing factors include: -long cord (> 100 cm) -malpresentation (breech) -transverse lie -unengaged presenting part -cord is at risk of compression= blocking oxygen and blood flow to baby. At onset of fetal distress, emergency c-sec should occur within 12 min 4. Rupture of the uterus -rare but serious injury. 1/2000 births -most frequent cause of uterine rupture occurs during: -separation of scar tissue of a previous c-sec -uterine trauma (accidents, surgery) -congenital uterine anomaly

Answer 16

Onset of labor may be difficult to determine for both nulliparous and multiparous women Familiar environment like home is ideal place for latent phase of first stage of labor Nurse assumes responsibility for assessing progress of labor and keeping midwife/physician informed of progress and deviations from expected findings FHR and pattern reveal fetal response to stress of labor process Assessing intake/output during labor and bladder is critical to ensure her progress and to prevent bladder injury

Answer 17

progress of labor is enhanced when a woman changes her position frequently during the first stage of labor Women with hx of sexual abuse often experience profound stress and anxiety during labor and birth siblings present for labor need preparation and support cultural beliefs and practices of a woman influence their approach to labor and birth

Answer 18

seminar 10

Answer 19

more common than post-term PTL: cervical changes (dilation and effacement) and uterine contractions occurring at 20-37 weeks of pregnancy Preterm birth: birth that occurs before the completion of 37 weeks (<37 +0 weeks of gestation) between 37-0 and 37-6 is a grey zone and not considered preterm because we would expect baby to act like a term baby

Answer 20

very preterm: <32 wks moderately preterm: 32-34 wks late preterm: 34 0/7 to 36 6/7 wks preterm birth vs Low Birth Weight (LBW) -preterm birth is length of gestation regardless of birth weight -LBW: <2500 g at birth -preterm is more dangerous than LBW alone because less time in the uterus means immature body systems before/at 32 wks = baby going to act differently because 25-26 wks is when surfactant starts to work to keep alveoli open and enables independent breathing after birth. No surfactant -> lung collapse IUGR is a cause for preterm and LBW. Intrauterine growth restriction cause by: Not enough fluid, not enough nutrition, multiple fetuses, weird shaped uterus etc.

Answer 21

Spontaneous: 75% of preterm births indicated: 25% of preterm births Causes of SPONTANEOUS preterm birth: **usually multifactorial because it is not ideal to bring baby out because they take longer to develop on the outside than inside the uterus -infection -congenital structural abnormalities of the uterus -placental causes -allergic reaction -decrease in progesterone -maternal and fetal stress -uterine overdistention: dt multiples or have had over 5 babies grandmultip = over 5 babies INDICATED -induced or c-sec because of a medical reason

Answer 22

Risk factors cervical length not predictive of PTL but a cervical length of >30mm = unlikely to give birth prematurely Fetal Fibronectin (fFN) test -swab that changes test strip a colour -fFN is a glycoprotein "glue" found in between chorion and decidua. it is present in cervical secretions -keeps fetal sac binded to uterine lining if glue is leaking out = movement in uterus

Answer 23

Pt teaching mostly activity restriction at home restrict sexual activity because it stimulates hormone release an orgasm causes uterine contraction/spasm of birth canal = changes in cervix

Answer 24

promotion of fetal lung maturity using Antenatal glucocorticoids. Umbrella of steroids that develop/bulk up organ maturation esp. lungs this significantly reduces incidence of respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, and death in neonates 24-26 wk range has 50/50 chance of life or death because they cannot survive on the outside

Answer 25

PROM= premature ROM -spontaneous rupture of amniotic sac and. leakage of fluid prior to onset of labor at any gestational age PPROM: preterm premature ROM -membranes rupture before 37 0/7 wks -water breaks but mom doesn't go into labor but baby is also preterm -responsible for 10% of all preterm births -often preceded by infection CHORIOAMNIONITIS -cant close membranes back up except if it is a hind leak, where the membranes don't rupture at the bottom, just at the top and the hole can be healed CARE -full term birth is best option -PPROM <32 wks is managed expectantly and conservatively -watch for signs of infection -fetal assessment; NST. two bands around belly to measure uterine activity and the ultrasound measures heartbeat -Antenatal glucocorticoids -7 day course of broad=spectrum antibiotics -administering magnesium sulfate for fetal neuroprotection

Answer 26

-bacterial infection of the amniotic cavity -major cause of complications at any gestational age -diagnosed by maternal fever, maternal and fetal tachycardia, uterine tenderness, and foul odor of amniotic fluid -tx is a cycle of IV antibiotics

Answer 27

>42 weeks gestation Maternal and Fetal risks: -maternal morbidity -dysfunctional labor and birth canal trauma -birth trauma and overextended uterus = causes for PPH -more likely for labor and birth interventions -prolonged labor -abnormal fetal growth (macrosomia) larger than normal head so fontanelles don't mold as easily -shoulder dystocia or operative birth risks -maternal pregnancy fatigue

Answer 28

induction/augmentation -cervical ripening -you can put meds on the cervix to make it start thinning = sends signals to body to produce oxytocin -sex can stimulate oxytocin -nipple stimulation produces sex hormones and stimulates contractions IV oxytocin but this restricts mom to an IV and the two bands around her belly Prelabor ROM - how long after ROM can mom be induced? Generally 30 hours until we get baby out due to risk of infection. Will depend on cervix, gest. age, confirmation that water is indeed broken, fetal state Preterm PROM - in hospital or on bedrest, monitoring for infection, getting glucocorticoids, getting magnesium sulfate. Magnesium sulfate, or mag for short, is used in pregnancy to prevent seizures due to worsening preeclampsia, to slow or stop preterm labor, and to prevent injuries to a preterm baby's brain. Magnesium sulfate is given as an intravenous infusion or intramuscular injection in the hospital over 12 to 48 hours.

Answer 29

seminar 10.2

Answer 30

-disorders that didn't exist before pregnancy -HTN chronic HTN, preeclampsia, HELLP syndrome, and eclampsia -gestational diabetes -hyperemesis gravidarum -hemorrhagic complications (PPH) -trauma -surgery during pregnancy -infections during pregnancy

Answer 31

leading cause of maternal morbidity and mortality SBP >140 mmHg DBP >90 mmHg SEVERE HTN -SBP >160 DBP >110 -proteinuria -cerebral disturbances -epigastric pain Gestational HTN: HTN develops at/after 20 wks gest. in woman without chronic HTN WITHOUT proteinuria Preeclampsia: HTN develops at/after 20 wks gest. in woman without chronic HTN WITH proteinuria eclampsia: seizure activity or coma in woman with diagnosed preeclampsia Superimposed preeclampsia: chronic HTN + preeclampsia after 20 wks gest.

Answer 32

Pathophysiology -poor perfusion dt vasospasm -aterial vasospasm decreased diameter of blood vessels = impedes blood flow to all organs and increases BP -pregnant women have increased blood volume = more cardiac effort = risk for vasospasm is higher risk factors: -age -obesity parity -diabetes -HTN -autoimmune diseases SIGNS and SYMPTOMS of preeclampsia -swelling of face or hands -fluid retention (decreased urine output) -sudden weight gain (>2lbs/wk or >6lbs/month) -persistent headache -seeing spots/vision changes -epigastric pain or in shoulder -n&v in 2nd half of preg. -dyspnea -tachycardia DIAGNOSTIC TESTS (not tested) -hematocrit - increase -kidney- increased BUN and uric acid -hepatic- decreased liver perfusion = elevated liver enzymes AST and ALT = indicates inflammation -bleeding time - decreased fibrinogen -endothelial cell dysfunction- placental ischemia CARE MANAGEMENT ASSESSMENT: -first sign: elevated BP second sign: proteinuria 3 Q's: headache? visual disturbances? RUQ epigastric pain? Fetal health surveillance: NST, contraction stress test (CST), lab tests mild contraction stimulation via iv oxytocin or nipple stimulation Mild Preeclampsia (at home) -activity restriction -diet -fetal health surveillance Severe Preeclampsia and HELLP syndrome: -hospital 1:1 care -O2 to help perfusion -magnesium sulfate -control of BP (want <160/110) -no NSAIDS (these elevate liver enzymes) Eclampsia: immediate care try to reduce consequences, cant resolve it HELLP syndrome: hemolysis, elevated liver enzymes, low platelets. Verr specific to HTN in prreg. -if not treated immediately = maternal and fetal mortality tx: delivery of baby and placenta if severe- c-sec, no trial of SVD

Answer 33

nursing care Get baseline: VS, O2 sat, LOC, DTR's (deep tendon reflexes) minimum monitoring: -continuous pulse oximetry -Q1h BP, HR, RR -Q4h LOC, temp, DTR's -foley cath -I&O q1h -max IV intake 80mL/hr Mg sulfate side effects; -facial flushing -hypotension -metallic taste -n&v -sweating -palpitations Toxicity: -muscle weakness -loss. of DTR's -hypothermia -resp. depression -altered cardiac condition, circulatory collapse

Answer 34

hyperglycemia -moms at risk of developing HTN -uncontrolled GDM can impact fetal development = LGA risk factors: age, hx, obesity, polycystic ovarian syndrome Interventions: -screening for GDM Antepartum: -diet, exercise, monitoring blood glucose levels, insulin therapy, fetal surveillance Intrapartum: -monitor q1h, FHR, no glucose IV bolus Postpartum: returns to normal, risk of type II DM later Care of Newborn -stabilize newborn blood glucose in first 2 hours of life -early S2S -initiation of BFing -frequent BFing -monitor blood sugar as per protocol + intervention to maintain level in target range -may be a medical indication for supplementation with expressed breast milk or formula if EBM not avail. *critial to ensure testing and feeds as per protocols -may need to be admitted to NICU for IV D10W Infant SYMPTOMS: -jittery -irritability -poor feeding -bradycardia -tachypnea -temp instability -sweating -pallor -weak cry -seizuers -hypotonia -loss of consciousness

Answer 35

N&V during pregnancy is the most common effect of pregnancy -HG is protracted vomiting, severe dehydration and weight loss = required hospitalization -usually begins in first 10 weeks Etiology: -increased estrogen and hCG associated with transient hypothyroidism Clinical Manifestations: -sig. weight loss of 10-11% -dehydration -low BP -increased pulse -poor skin turgor Assessment: -severity- frequency, duration, diarrhea, weight, fluid/electrolytes, ketonuria, CBC, psychosocial Initial Care: -clear fluids with protein -IV start -I&O -Antiemetics; ondansetron metoclopramide dimenhydrinate diclofenac (the only pregnancy-specific one) teaching: small frequent meals, high protein, bland, Mg, K, decrease odors

Answer 36

medical emergency dt hypovolemia third semester bleeding is dt placenta previa or placental abruption early pregnancy bleeding is dt miscarriage aka spontaneous abortion -clinical manifestations: back pain, cramps, bleeding Early preg 1-6 wks: heavy menstrual flow Early preg 6-12 wks: mod. discomfort, blood loss Lat preg: 12-20 wks: infection, cervical dilation Types of hemorrhagic; threatened- bleeding contractions inevitable- started, not stopping complete- over incomplete, missed Assessment: -U/S -lab tests -s&s of infection Nursing Care: -antibiotics -transfusion iron supplements community support. for loss

Answer 37

less common than miscarriage passive and painless without contractions or labor etiology: -past trauma short cervix -D&C - dilation and curettage Dilation and curettage (D&C) is a procedure to remove tissue from inside your uterus. Health care providers perform dilation and curettage to diagnose and treat certain uterine conditions — such as heavy bleeding — or to clear the uterine lining after a miscarriage or abortion. TX: bed rest hydration prophylactic cerclage (tie cervix shut) - removed at 35-37 wks monitor for contractions, PROM, infection home care: bed rest, know emergency phone numbers

Answer 38

fertilized ovum implanted outside the uterine cavity, most occurs in fallopian tube. Ovary, abd. cavity, cervix also possible locations not a viable pregnancy. it will never get past the trophoblast stage so immediate tx needed to save mom and her fertility salpingectomy: removal of fallopian tube salpingostomy: surgical opening of fallopian tube clinical manifestations: -missed menstrual period -abd. pain -mild-moderate dark red or brown intermittent bleeding care: pre + post op care, VS, discuss future fertility grief and loss, infertility support groups

Answer 39

placenta implanted in lower uterine segment near/over cervical os complete previa: covers os completely marginal previa: 2.5 cm or lower to the os low-lying placenta: no measurement of edge of placenta to os diagnosis: U/S Risk factors: previous placenta previa, C-sec, endometrial scarring clinical manifestations: -painless bright red bleeding in 2nd or 3rd trimester Maternal and fetal complications: -hemorrhage, poor placental exchange, abnormal placental attachment, hysterectomy fetal risks: malpresentation, stillbirth, fetal anemia preterm birth hemorrhage: the weight of the fetus is sitting on the internal os

Answer 40

premature separation of the placenta risk factors: -HTN -trauma -cocaine use -PROM -twins grades: mild, mod, severe Clinical Manifestations: -partial or complete separation -dark bleeding, no clots -abd./back pain -port-wine stained amniotic fluid -contractions -uterine tenderness Maternal complications: hemorrhage hypovolemic shock thrombocytopenia (low platelets) renal failure Fetal complications: abnormal FHR pattern neuro defects IUGR SIDS death

Answer 41

Placenta accrete: aka placenta previa. trophoblastic invasion extends beyond normal endometrial barrier Placenta increta: extends into the myometrium Placenta percreta: extends beyond the uterine serosa basically, placenta can burrow into layer of uterine lining which interferes with blood flow and separation

Answer 42

STI's - impact fertility and morbidity UTI - very common -asympomatic bacteriuria. tx. antibiotics, repeat urine culture -Cystitis (bladder infection). dysuria, urgency, suprapubic pain. tx. 3 day course of antibiotics which may stain urine orange -Pyelonephritis: 2nd semester feverr, chills, pain in lumbar back, n&v,

Answer 43

Physical trauma: includes MVA, falls, burns, violence. (Manual Vacuum Aspiration) effect on preg depends on: -length of gestation at time of trauma -type and severity -degree of disruption of uterine and fetal physiological features Significance: leads to placental abruptions and hemorrhage (pulling apart from uterine wall)

Answer 44

emergency c-sec within 4 min of cardiac arrest. or unsuccessful resus of mom poor fetal survival with c-sec >20 min after maternal death Rarely successful

Answer 45

PPH -loss of >500 ml (vag) loss of >1000 ml (c-sec) -any blood loss that has the potential to cause hemodynamic instability early/primary- within 24 hours of birth late/secondary- >24 hr - 6 wks post birth causes: -retained placental fragments -infection -subinvolution of uterus (not decreasing in size) Etiology: 4 T's 1. Tone uterine atony, hypotonia 2. Tissue retained placental fragments, placenta accreta/increta/percreta 3. Trauma laceration of birth canal, uterine inversion, hematomas 4. Thrombin clotting disorders ASSESSMENT early recognition is critical -evaluate contractility of uterus firm fundal massage admin IV fluids and meds to manage bleeding active management of 3rd stage to prevent PPH: admin oxytocin after delivery of fetal shoulder + immediate fundal massage after complete birth hypotonic uterus - massage, eliminate bladder distension, IV Bleeding with a contracted uterus - manual exploration of uterine cavity for placenta Pharmacologic tx: homeostatic actions or oxytocin agents

Answer 46

Puerperal infection: any infection of genital canal within 28 pp streptococcal organisms wound infections UTI Mastitis Endometritis

Answer 47

disorders of uterus and vagina related to pelvic relaxation and urinary incontinence resulting from child-bearing more risk if grand multip uterine displacement and prolapse or retroversion Cystocele: protrusion of bladder downward into vagina when support structures are injured rectocele: herniation of the anterior rectal wall through relaxed or ruptured vaginal fascia and rectovaginal septum

Answer 48

Interfere with attachment may threaten safety of mother, newborn, and other children Perinatal mood disorders (PMD) mild depression/baby blues more serious depression PPD PP anxiety disorders: -generalized anxiety disorder -obsessive-compulsive disorder -panic disorder and panic attacks -specific phobias -social anxiety disorder-post0traumatic stress disorder PPD without psychotic features: -low mood, lack of interest in activities -tx: antidepressants, antianxiety, electroconvulsive therapy psychotherapy focuses on fears and concerns of new responsibilities and roles, monitor for suicidal/homicidal thoughts PP Psychosis: -depression, hallucinations, delusions, thoughts of harm to self/infant -emergency, may require hospitalization -tx: antipsychotics, mood stabilizers like lithium are tx of choice Nursing Care: -screen for perinatal mood disorder -referral -provide safety psychiatric hospitalization -psychotropic meds

Answer 49

loss of control during birthing experience, hopes and dreams -birth of child with complex condition -death -grief is part of recovery from loss -many emotional, physical, behavioural, cognitive responses -phases in grief process: acute distress, searching and yearning, disorientation, reorganization and resolution Nursing Care: -help family actualize loss -facilitate positive coping -provide post mortem care respecting parents' wishes Maternal Death: -rare -family at risk of altered parenting of baby and siblings

Answer 50

Seminar 11

Answer 51

1. Respiratory Distress Syndrome (RDS) 2. Patent ductus arteriosus (not closing properly) 3. Periventricular-intraventricular hemorrhage 4. Necrotizing enterocolitis (tissue death in GI tract) 3 and 4 not tested on

Answer 52

born <37 weeks Extremely low birth weight: <1000 g -organ systems immature -lack adequate physiological reserves to function in extrauterine environment -lower birth weight and low gest. age = low chance of survival -responsible for 40% of infant deaths High risk infants: sizes: -LBW -very VLBW -extremely ELBW -AGA - appropriate for gest age -SFD -Sym/Assym IUGR Gestational age; -early preterm -preterm -late preterm -full term -late term -post term very preterm: <32 wks moderately preterm: 32-34 wks late preterm: 34 0/7 to 36 6/7 wks Higher risk of: -resp distress -cold, stress, thermoregulation -hypoglycemia -hyperbilirubinemia -feeding concerns -sepsis

Answer 53

fatigue easily- do not have energy stores + likely to have jaundice uncoordinated suck and swallow reflex and breathing - bradycardia hypoglycemia need for supplementation Gavage feeding: (more in NICU) -intermittent indwelling nasogastric tube feed

Answer 54

Less brown fat, no shiver, higher surface area, lower glycogen stores = nothing to use for heat production

Answer 55

1 Fewer alveoli 2. Not much surfactant -surfactant allows lungs to expand smoothly 3. Smaller lumen in airways 4. Greater collapsibility of airways 5. Weak gag reflex 6. Potential for aspiration ASLCGA All sexy ladies can get acne Alveoli - fewer Surfactant - less Lumen - smaller Collapse - greater Gag - weak Aspiration - risk of

Answer 56

usually closes within hours delay dt oxygenation and circulating prostaglandin

Answer 57

-tachypnea -nasal flaring -grunting -use of accessory muscles

Answer 58

transplacental transfer of infectious agents the 5 common ways neonates get infections: T- toxoplasmosis (chemicals) O - viruses (syphilis, HIV, varicella, west nile) R - rubella C - cytomegalovirus (CMV) H - herpes simplex virus HSV is a genital STI, causes cervical cancer and symptoms are easily overlooked and progress quickly to stage 3 or 4 Risk factors for infection: -review antenatal record -PROM - source of infection -Chorioamnionitis -intrapartum maternal temp >38 -delivery <37 wks gest. -positive GBS -membranes rupture> 18 hours Signs & Symptoms of Newborn infection: -APGAR <6 -lethargy with poor tone -poor feeding -unstable temp -resp. distress which includes: -tachycardia -grunting -nasal flaring -use of accessory muscles Care: -inform PCP and consult pediatrician -transport ITT -admission to nursery or NICU -IV start -CBC, CRP, blood cultures -cardioresp monitors -lumbar puncture

Answer 59

is a group of conditions caused when a baby withdraws from certain drugs he's exposed to in the womb before birth Alcohol: FAS, craniofacial features, microcephaly, attention deficits, hyperactivity, developmental delays Tobacco: preterm, LBW, SIDS, risk for bronchitis and pneumonia, orofacial clefts, develop. delays Marijuana: tremors, LBW, IUGR, attention problems Cocaine: preterm, SGA, microcephaly, poor feeding, irreg. sleep pattern, visual attention, hyperactivity, diff. to console, hypersensitivity, develop delays, congenital anomalies Heroin: LBW, SGA, irritability, tachypnea, diff. feeding, vomiting, high-pitched cry, seizures Organogenesis happens in first 8 weeks from conception = tobacco and marij use in first trimester has same long-term effects as alcohol Naloxone (Narcan) is contraindicated for infants of women addicted to narcotics because it hyperboosts what the body needs = causes high heart rate

Answer 60

>42 wks gest regardless of BW Risk of: Meconium Aspiration Syndrome (MAS) -dt stress in utero -sticky tar in lungs affects alveoli = diff. breathing = low APGAR - also likely to swallow meconium and aspirate can lead to PPHN Persistent Pulmonary HTN of the Newborn: (PPHN) pulm. HTN occurs when pulmonary vascular resistance (PVR) remains abnormally elevated after birth, resulting in right-to-left shunting of blood through fetal circulatory pathways.

Answer 61

usually have diabetic mothers risk of: birth injuries hypoglycemia cardiomyopathy RDS congenital anomalies Care: -assessment and identification of problems -serum blood glucose levels monitoring -monitor for birth injuries, referrrals

Answer 62

usually have diabetic mothers risk of: birth injuries hypoglycemia cardiomyopathy RDS congenital anomalies Care: -assessment and identification of problems -serum blood glucose levels monitoring -monitor for birth injuries, referrrals

Answer 63

U/S enables antepartum diagnosis of fetal conditions that may be treated in utero or shortly after birth elective c-s to prevent signif. injury during birth causes: LGA - large cranium shoulder dystocia Care: -skeletal injuries - handle with more care -peripheral nervous system injuries -palsy- intermittent, incomplete sensation and motor control -paralysis - lack feeling or motor control

Answer 64

(ABO incompat. NOT TESTED - relevant to NICU) ABO incompatibility: maternal antibodies cross placenta and attack fetal RBC = hemolysis if fetal blood is A, B, or AB and mom is O, then naturally occurring anti-A and anti-B antibodies are transferred across placenta to fetus - -exchange transfusions required occasionally hyperbilirubinemia = rapid rate of RBC destruction Rh incompatibility "isoimmunization" -maternal antibodies present naturally or form a response to antigen from fetal blood crossing the placenta and entering maternal circulation -Rh + with Rh - mom: baby is at risk because mom will form antibodies against fetal RBC's -mom receives rhoGAM at 28 wks and another dose after birth within 72 hrs

Answer 65

the most major congenital anomalies causing serious problems in neonates: -congenital heart disease - apply oximeter -abd. wall defect -imperforated anus (no hole) -neural tube defect -cleft lip/palate -clubfoot -developmental dysplasia of the hip Nursing Care: -genetic diagnosis in newborn screening -hypothyroidism - iodide deficiency, cog. impairment. Tx: thyroid hormone replacement (heel stick test) -Phenylketonuria (PKU)- caused by deficiency of enzyme that metabolizes phenylalanine (an essential amino acid) = accumulation of phenylalanine in blood stream and urine. Clinical manifestations: failure to thrive, vomiting, cog, impairment, irritability, hyperactivity -galactosemia- gene mutations- enzymatic deficiencies (conversion of galactose into glucose) tx: eliminate all milk and lactose

Answer 66

seminar 12

Answer 67

transmission: blood and body fluids incurable: hep B, genital herpes, HPV, HIV reportable in BC: gonorrhea, syphilis, chlamydia, HIV, AIDS, Hep A, B, C prevention is key -risk assessment identify high risk behaviours, provide safer sex options -behaviour is driven by perceived risk so if they don't believe there are serious consequences, they wont change their behaviour Nursing Care: -provide specific, unbiased information -private setting

Answer 68

transmission: blood and body fluids incurable: hep B, genital herpes, HPV, HIV reportable in BC: gonorrhea, syphilis, chlamydia, HIV, AIDS, Hep A, B, C prevention is key -risk assessment identify high risk behaviours, provide safer sex options -behaviour is driven by perceived risk so if they don't believe there are serious consequences, they wont change their behaviour Nursing Care: -provide specific, unbiased information -private setting

Answer 69

a safe, effective inexpensive, simple, available, reversible, doesn't effect pleasure = doesn't exist Barriers to Access: embarrassment, rural, cost, privacy, taboo to bring it up, not available when sex happens, consumption of alcohol, cannabis Methods: 1) hormonal -different combinations of estrogen and progesterone avail -can be used longterm -caution using estrogen-based pill for smokers and >35 years old -proper use = 99.9% effective -must take at same time every day -if 1 missed, take asap, take next pill at regular time. no supp. contraception needed. -if 2 missed, Depends on what week of your ovulation cycle you are on. If week 1 or 2: Take 2 pills per day for 2 days and finish package. Use supp. contraception for 7 days. If week 3: If sunday starter: take 1 pill everyday til Sunady, start new pack on Sunday. Week 3 if day 1 starter: throw away rest of pack, start new pack on same day -if 3+ missed, same as if 2 missed pills. -smoking reduces effectiveness -contraindications: hx breast cancer, migraine with aura and seizure disorders (most anticonvulsants are contraindicated with OCPS), pregnancy and lactation, HTN, type I and II DM, heart issues Benefits: -most effective form of contraception -regulates cycle -reduces flow -help acne by changing titrations of est. and prog. -protects against certain cancers completely reversible -also have hormone patches -NuvaRing - no STI protection -chemical- injectable hormone. long-lasting Depo-Provera **ideal contraception if woman is on anticonvulsants because the anticonvulsants can interfere with the combined OCP** -intrauterine device that leaches small amounts of hormones to prevent implantation 2) Barrier -male/female condoms -diaphragm and cervical cap -toxic shock syndrome. risk so never use during menstrual bleeding and up to 6 wks pp and remove 6-8 post insertion. must be refitted after any gyne surgery, birth, major weight loss/gain 3) Chemical -spermicide need >15 min before ejaculation for efficacy not 100% effective against certain STI's 4) Sterilization Tubal ligation Vasectomy 5) Natural methods Fertility rhythm awareness: -need to know signs of pre-ovulation ovulation, post-ovulation Cervical mucus method: -cervical mucus changes consistency throughout cycle to help keep sperm alive and moving during highest fertility - mucus is thinner, milky white. Increase of mucus buildup in quantity in the 24 hours right before ovulation. Breastfeeding method: -BFing doesn't prevent ovulation so not too reliable dt possibility of having cycles without menses where ovulation still occurs and because variations in hormones between day and night and week to week depending on BF habits of infant -encourage BFing mothers resuming sexual intercourse after vaginal birth to use water-soluble lubricants dt less vaginal lubricant during BF (hormone related) Withdrawl Basal body temp (BBT) EMERGENCY Contraceptive pill: PLAN B -erquired prescription -use within 120 hours (5 days) of unprotected sex -does not end an impanted pregnancy = does not cause an abortion it only stops trophoblasts from developing. The trophoblast is the cell division (meiosis) right before implantation. IF the egg is fertilized and implants, the Plan B hormone cannot impact it. If it could, that could be argued as abortion (ending a potential life) -side effects of nausea so take anti-nausea 1-2 hours before -decreases chance of pregnancy by 60-85%

Answer 70

STI transmission is an ongoing epidemic be unbiased, professional, non-judgmental provide safe, open discussions to make pts comfortable truthfully inquire about their needs/concerns understand pt's lived reality assist pts to find a method that meets their needs nd matches their values

Answer 71

sperm issues - low production, motility ovarian factors - quality of eggs, number of eggs uterine factors - fibroids, cystic BMI Age Endometriosis Nursing role in fertility: -sensitive -assess knowledge and lifestyle issues -assess needs and support -referral to reproductive specialist, counseling Impact of infertility: -perceived as loss -loss cycle: shock denial anger bargain depression guilt/unworthiness acceptance

Answer 72

Indications vary medications to prepare ovulation egg retrieved partner provides semen lab combines egg and sperm embryos are incubated then implanted directly into uterus

Answer 73

Reasons for termination: Therapeutic: when mom's health/life is in danger if pregnancy continues Eugenic: when the child is thought to be unable to live or to suffer severe disability Psychiatric: when the mental health of the mother is threatened by the pregnancy Ethical: pregnancy is the result of incest or rape On demand: at the request of mother or any reason Accessibility in BC: -7 abortion clinics in BC (Kelowna, Kootenays, Victoria, 4 in lower mainland). No referral needed -up to 20 weeks although most occur before 13 weeks -complications happen <1:100 but include infection hemorrhage, cervical tear -teenagers do not require parental consent and clinics must keep their names confidential Abortion methods: 1st trimester 1) Medication: -Misoprostol (cytotec): causes uterine contractions -Methotrexate: destroys rapidly dividing cells, blocks folic acid for cell division (stops process) 2) Surgical -Vacuum-aspiration: suction applied to evacuate contents of uterus with or without cervical dilation (depends on how many weeks). Occurs in clinic or hospital Canada does not use mifepristone (RU486) Abortion methods: 2nd trimester 1) D&E (dilation and evacuation -aspirotomy) aka dilation and curettage -dilate cervix, bigger cannula for vacuum -forceps to remove tissue pieces -currette to scrape uterus lining -sonar, sedative, general or spinal anesthetic 2) Induction (2nd and 3rd trimester) -dilation of cervix, labor, birth medications: oxytocin IV saline, digoxin or potassium chloride into amniotic sac prostaglandins such as misoprostol vaginally risks of an abortion: 95% successful -surgical most often used -bleeding. dt retained products -> infection or hemorrhage -cervical or uterine damage -emotional damage abortions do not usually affect future fertility Nurse's role: duty to provide care ethical standards of practice professional boundaries

final exam Flashcards

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